More likely to suffer falls, other complications, study finds

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CHICAGO — Hospital patients put in isolation because of contagious infections may be more likely to suffer falls, bedsores and other preventable complications, suggesting they get inadequate care, a study found.

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Some of the differences “are likely a result of the isolated patients being ‘out of sight’ and therefore ‘out of mind,”’ said Dr. Henry Thomas Stelfox of Harvard’s Brigham and Women’s Hospital.

Also, “the effort and time involved in donning protective equipment likely discourages some providers from visiting their patients as frequently as they otherwise would.”

Thomas led the study at two large teaching hospitals — Brigham and Women’s in Boston, and Sunnybrook and Women’s College Health Sciences Centre in Toronto. The findings appear in Wednesday’s Journal of the American Medical Association.

Isolation typically involves putting the patient in a private room, limiting the number of visitors and health workers who treat the person, and requiring protective clothing for anyone entering the room.

Patients typically are isolated if they have an extremely contagious disease like SARS, if they are infected with germs that are resistant to antibiotics, or if they are especially prone to infection themselves.

“This article is very timely because people are trying to think about if SARS returns, how do we use isolation to be helpful?” said James Bentley, a senior vice president of the American Hospital Association. All hospitals need “to make sure that the benefits of isolation “aren’t undermined by the negatives.”

The study involved 148 patients isolated because of antibiotic-resistant staphylococcus germs. Their care was compared with that of non-isolated patients who had similar conditions and were treated by the same or similar doctors.

While in-hospital death rates did not differ, isolated patients faced double the risk of experiencing preventable adverse outcomes, and an even higher risk of specific complications such as falls and bedsores.

Isolated patients were more likely to have their vital signs inaccurately recorded and more likely to have days in which nurses and doctors put no notes on their charts.

The researchers said it is unlikely that doctors and nurses deliberately neglected isolated patients, and Thomas said fear of contracting an infection probably played only a small role.